A. Debbie C. Jaarsma

How clinical medical students perceive others to influence their self-regulated learning

Undergraduate medical students are prone to struggle with learning in clinical environments. One of the reasons may be that they are expected to self‐regulate their learning, which often turns out to be difficult. Students’ self‐regulated learning is an interactive process between person and context, making a supportive context imperative. From a socio‐cultural perspective, learning takes place in social practice, and therefore teachers and other hospital staff present are vital for students’ self‐regulated learning in a given context. Therefore, in this study we were interested in how others in a clinical environment influence clinical students’ self‐regulated learning.

Dealing with emotions: medical undergraduates' preferences in sharing their experiences

Patient care evokes emotional responses such as uncertainty, grief and pride in medical students. There is a need for opportunities to share and express such emotions because they influence students’ professional development and well‐being. There is a trend towards introducing mentor programmes into medical curricula. It remains unknown whether students are willing and able to share their emotional experiences within this formal setting. We set out to explore how medical students share their emotional experiences and why.

What supervisors say in their feedback: construction of CanMEDS roles in workplace settings

The CanMEDS framework has been widely adopted in residency education and feedback processes are guided by it. It is, however, only one of many influences on what is actually discussed in feedback. The sociohistorical culture of medicine and individual supervisors’ contexts, experiences and beliefs are also influential. Our aim was to find how CanMEDS roles are constructed in feedback in a postgraduate curriculum-in-action. We applied a set of discourse analytic tools to written feedback from 591 feedback forms from 7 hospitals, including 3150 feedback comments in which 126 supervisors provided feedback to 120 residents after observing their performance in authentic settings. The role of Collaborator was constructed in two different ways: a cooperative discourse of equality with other workers and patients; and a discourse, which gave residents positions of power—delegating, asserting and ‘taking a firm stance’. Efficiency—being fast and to the point emerged as an important attribute of physicians. Patients were seldom part of the discourses and, when they were, they were constructed as objects of communication and collaboration rather than partners. Although some of the discourses are in line with what might be expected, others were in striking contrast to the spirit of CanMEDS. This study’s findings suggest that it takes more than a competency framework, evaluation instruments, and supervisor training to change the culture of workplaces. The impact on residents of training in such demanding, efficiency-focused clinical environments is an important topic for future research.

Context matters when striving to promote active and lifelong learning in medical education

In the 30 years that have passed since The Edinburgh Declaration on Medical Education, we have made tremendous progress in research on fostering ‘self‐directed and independent study’ as propagated in this declaration, of which one prime example is research carried out on problem‐based learning. However, a large portion of medical education happens outside of classrooms, in authentic clinical contexts. Therefore, this article discusses recent developments in research regarding fostering active learning in clinical contexts.

Nothing is as practical as a good theory

This is the third issue of Perspectives on Medical Education. PME aims to share with you, our reader, the growing body of knowledge and understanding in the broad domain of health professions education. We aim to inspire you to conduct (more) research yourself and to contribute to the building of a coherent body of evidence. Additionally we hope to increase a further understanding of learning in this domain and to better inform the decision making on educational matters in your institute. To accomplish this PME strives to publish papers that are of high quality, addressing innovative topics and challenging research questions through well-designed studies. PME values the richness of the health professions educational domain, literally intertwining health professions and education, with authors and readers from a wide variety of backgrounds. Practitioners and scientists from both the biomedical and the social science domains collaborate in creating the best possible education and to provide the evidence base that informs practice [1]. As the professionals who are involved in medical education come from such diverse backgrounds, PME will cherish and publish papers with a wide variety of perspectives on learning, teaching and assessment, preferably well grounded in theoretical/conceptual frameworks. Perspectives from disciplines such as psychology, education, sociology and anthropology are used more and more to understand and explain learning and to guide the design of educational activities [1]. The diversity displayed by the papers in this issue truly lives up to our aim of sharing that broad range of perspectives that exists in our domain. The papers live up to the title of our journal! The paper by Van Den Broek et al. on students’ instructions before conducting a Script Concordance Test is of great value for researchers, teachers and others involved in assessments with SCTs. From a theoretical point of view their study helps to enhance our understanding of the SCT and opens up the discussion on test reliability and the influence of validity. From a more practical point of view the study is of interest since it shows how something relatively ‘simple’ as an instruction in how to approach a test, may have large consequences for the validity of that test. The authors have their backgrounds in medicine and psychology, uniquely combining their expertise [2]. Berghmans et al. also inform both theory and practice by bringing back to life the old discussion about directive (e.g., teacher-centred) and facilitative (e.g., student-centred) training approaches and the influence on learning outcomes. In this paper a quasi-experimental design is presented with medical students trained as peer teachers in clinical skills. The trained students were less positive about the facilitative training approach than about the directive approach [3]. Understanding why this is the case would call for more in-depth studies. Observational studies that take into account the purpose of the clinical training and what students actually do could inspire such research. The discussion ends with the intriguing notion that students’ preferences and expectations should not always be met [3]. A practical study is presented by Boudreau et al. on a faculty development workshop on narrative-based reflective writing. The authors may be commended on their own self-reflectiveness on the outcomes and generalisability of their workshop template [4]. This study inspired me to start using the concept of narrative approaches and elements of the workshop in my own institution. Henning et al. [5] focused on the well-being of international and domestic students and the potential influence on academic performances, an often neglected topic in the research literature [6]. This is a descriptive study that informs all of us responsible for student affairs to make sure that students (and especially international students) are provided with social networks and that support systems are in place. The importance of emotional support to students, among other variables that influence students’ motivations, is extensively studied by Rashmi Kusurkar. A short summary of her PhD thesis on Motivation in Medical Students is presented in this issue [7]. Her work sheds a new perspective on medical education valuing student motivation as an important component of curriculum design. Kusurkar’s thesis consists of empirical studies and application to practice studies. A marvellous example of how deepening theoretical understanding intelligently informs practice. A must read for everyone in our domain. I wish you much joy and academic inspiration in reading this issue. Hopefully it broadens your perspective.

Is being a medical educator a lonely business? The essence of social support

Social support helps prevent burnout and promotes its positive opposite, work engagement. With higher work engagement performance increases. The context‐specific aspects of social support for medical educators, in their educator role, are unknown. To help facilitate social support our study describes the essential elements of social support and their meaning for medical educators.

Integrated and implicit: how residents learn CanMEDS roles by participating in practice

Learning outcomes for residency training are defined in competency frameworks such as the CanMEDS framework, which ultimately aim to better prepare residents for their future tasks. Although residents’ training relies heavily on learning through participation in the workplace under the supervision of a specialist, it remains unclear how the CanMEDS framework informs practice‐based learning and daily interactions between residents and supervisors.

A feedback system in residency to evaluate CanMEDS roles and provide high-quality feedback: Exploring its application

Abstract Introduction: Residents benefit from regular, high quality feedback on all CanMEDS roles during their training. However, feedback mostly concerns Medical Expert, leaving the other roles behind. A feedback system was developed to guide supervisors in providing feedback on CanMEDS roles. We analyzed whether feedback was provided on the intended roles and explored differences in quality of written feedback. Methods: In the feedback system, CanMEDS roles were assigned to five authentic situations: Patient Encounter, Morning Report, On-call, CAT, and Oral Presentation. Quality of feedback was operationalized as specificity and inclusion of strengths and improvement points. Differences in specificity between roles were tested with Mann–Whitney U tests with a Bonferroni correction (α = 0.003). Results: Supervisors (n = 126) provided residents (n = 120) with feedback (591 times). Feedback was provided on the intended roles, most frequently on Scholar (78%) and Communicator (71%); least on Manager (47%), and Collaborator (56%). Strengths (78%) were mentioned more frequently than improvement points (52%), which were lacking in 40% of the feedback on Manager, Professional, and Collaborator. Feedback on Scholar was more frequently (p = 0.000) and on Reflective Professional was less frequently (p = 0.003) specific. Discussion and conclusion: Assigning roles to authentic situations guides supervisors in providing feedback on different CanMEDS roles. We recommend additional supervisor training on how to observe and evaluate the roles.

Leadership in the clinical workplace: what residents report to observe and supervisors report to display: an exploratory questionnaire study

BackgroundWithin the current health care system, leadership is considered important for physicians. leadership is mostly self-taught, through observing and practicing. Does the practice environment offer residents enough opportunities to observe the supervisor leadership behaviours they have to learn? In the current study we investigate which leadership behaviours residents observe throughout their training, which behaviours supervisors report to display and whether residents and supervisors have a need for more formal training.MethodsWe performed two questionnaire studies. Study 1: Residents (n = 117) answered questions about the extent to which they observed four basic and observable Situational Leadership behaviours in their supervisors. Study 2: Supervisors (n = 201) answered questions about the extent to which they perceived to display these Situational Leadership behaviours in medical practice. We asked both groups of participants whether they experienced a need for formal leadership training.ResultsOne-third of the residents did not observe the four basic Situational Leadership behaviours. The same pattern was found among starting, intermediate and experienced residents. Moreover, not all supervisors showed these 4 leadership behaviours. Both supervisors and residents expressed a need for formal leadership training.ConclusionBoth findings together suggest that current practice does not offer residents enough opportunities to acquire these leadership behaviours by solely observing their supervisors. Moreover, residents and supervisors both express a need for more formal leadership training. More explicit attention should be paid to leadership development, for example by providing formal leadership training for supervisors and residents.

Work engagement in health professions education

Abstract Work engagement deserves more attention in health professions education because of its positive relations with personal well-being and performance at work. For health professions education, these outcomes have been studied on various levels. Consider engaged clinical teachers, who are seen as better clinical teachers; consider engaged residents, who report committing fewer medical errors than less engaged peers. Many topics in health professions education can benefit from explicitly including work engagement as an intended outcome such as faculty development programs, feedback provision and teacher recognition. In addition, interventions aimed at strengthening resources could provide teachers with a solid foundation for well-being and performance in all their work roles. Work engagement is conceptually linked to burnout. An important model that underlies both burnout and work engagement literature is the job demands-resources (JD-R) model. This model can be used to describe relationships between work characteristics, personal characteristics and well-being and performance at work. We explain how using this model helps identifying aspects of teaching that foster well-being and how it paves the way for interventions which aim to increase teacher’s well-being and performance.